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Gracilis flap and partial colpocleisis of Kahr for pelvic organ prolapse after anterior exenteration: A case report

Year: 2024

Type: article

Abstract: Anterior exenteration is a radical surgical option for treating locally advanced pelvic malignancies when alternative treatments are deemed ineffective or inappropriate. Due to its nature as an ablative treatment, interference with supportive structures of the pelvic floor can result in pelvic organ prolapse. A 70-year-old woman presented with prolapse after radical cystectomy and following two unsuccessful attempts at Le Fort colpocleisis, the second of which was further complicated by rupture of the vaginal cuff. After exploratory laparotomy to evaluate pelvic adhesions and potential tumor recurrence, the necrotic vaginal apex was excised via the vaginal route, and a musculus gracilis flap was created to cover the levator hiatus in a Z -shaped pattern. The introitus was then narrowed by partial colpocleisis of Kahr. The postoperative course was uneventful and high patient satisfaction and an adequate anatomic result were found at one-year follow-up. There is a scarcity of literature regarding the optimal treatment for pelvic organ prolapse after anterior exenteration, and to our knowledge this is the first published report of the use of a gracilis flap combined with partial colpocleisis of Kahr with a satisfactory outcome in this complicated situation. This case underscores the importance of a multidisciplinary approach in managing prolapse after radical cystectomy, showcasing the successful integration of expertise across gynecology, urology, and reconstructive surgery. • Management of recurring prolapse after radical cystectomy in a 70-year old woman is described. • Two earlier repairs had failed, one causing rupture of the vaginal cuff. • Management involved a combination of Gracilis flap and Kahr colpocleisis. • There was no recurrence over one-year follow-up. • The case underscores the importance of a multidisciplinary approach.

Source: Case Reports in Women s Health

DOI: 10.1016/j.crwh.2024.e00673

Authors: Greta Lisa Carlin, Sören Lange, Werner Haslik, Harun Fajkovic, Engelbert Hanzal

Institutions: Medical University of Vienna, University of Zurich, University Hospital Zurich, Universitätsklinikum St. Pölten

Language: English

Topic: Pelvic floor disorders treatments

Subfield: Rheumatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $860